Recirculation Measurement Overview Prerequisite Review HD03 Hemodialysis Monitor Delivered Flow Recirculation and Access Flow PowerPoint Training Introduction Training Outline Detailed Recirculation Procedure Steps ID: 931842
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Slide1
HD03 Hemodialysis Monitor Training
Recirculation Measurement
Slide2Overview
Prerequisite:
Review HD03 Hemodialysis Monitor: Delivered Flow, Recirculation
,
and Access Flow PowerPoint Training Introduction
Training Outline:
Detailed Recirculation Procedure Steps
Clinical interpretation for Catheters and AV Fistula or Grafts
Slide3Set up for Recirculation Measurement
Utilize the steps detailed in the
HD03 Hemodialysis Monitor: Delivered Flow, Recirculation, and Access Flow PowerPoint Training Introduction to select the proper bloodlines (tubing), sensor placement, basic troubleshooting, and disinfection procedures.
Slide4Place Sensors on Bloodlines (Tubing)
Recirculation Steps:
Properly place Arterial & Venous Sensors on the bloodlines (tubing)
Slide5Choose Recirculation Protocol
Recirculation Steps:
Select the Recirculation Icon
Slide6Saline Dilution: Release or Bolus
Recirculation Steps:
Saline release from the saline bag
OR
Saline bolus into the venous drip chamber via port (pigtail)
NOTE: The Traffic Light remains
red
for one minute as the HD03 obtains the baseline flow. Do not follow the on-screen instructions until the Traffic Light turns
green
.
Slide7Saline Dilution: Release Method
Most saline lines have at least one inline clamp.
Some saline lines have two with one by the bag and one closer to the saline infusion site on the Arterial Line (pre pump).
Slide8Saline Dilution: Release Method
Saline Release Steps
WHEN THE TRAFFIC LIGHT TURNS
GREEN
Open venous pressure limits to avoid pump stoppage
Open saline clamps to release saline from infusion bag for 5-6 sec
Do not clamp off the Arterial bloodline, just open the saline clamps to allow the saline to slowly infuse approximately 10 mL’s of saline from the bag
Saline Dilution: Release Method
(Click to Show Animation)
Slide10Saline Dilution: Bolus Method
Saline Bolus Steps
Hemodiafiltration machines utilize purified dialysate instead of a saline bag.
Inject 10 mL saline into or before venous bubble trap via the injection site (pigtail).
Slide11Saline Dilution: Bolus Method
(Click to Show Animation)
Slide12Saline Dilution: Bolus Method
Saline Bolus Steps
Attach a 10cc syringe filled with 10mL of saline to the injection site (pigtail)
Open the injection site (pigtail) clamp
Inject the 10mL of saline smoothly over 3-4 seconds into or before venous bubble trap via the injection site (pigtail)
Slide13Open/Spread Venous Pressure Limits During Release/Bolus
If alarm occurs or blood pump is stopped for any reason
,
the measurement must be repeated.
Open/Spread the pressure alarm limits as the saline is being infused and until the saline has cleared the venous bloodline- typically this occurs once the screen progresses to the Analyzing screen
Technical Note: Expanding Pressure Limits to Avoid Pump Alarms during HD03 Recirculation and Vascular Access Measurements available with the HD03 Tools
Slide14Recirculation Measurement Results
Results Steps
DTM Users: Results will be saved on the DTM and can be viewed under the Patient Record icon.
PMM Users:
MUST
Manually record results into the patient’s treatment/medical record
.
The result will clear once Next Patient icon is activated.
Recirculation Measurement can be repeated as needed once the stoplight turns green again and displays READY.
Slide15Patient Information
Patient Record
Displayed at the top of the Patient Record screen is the Patient name, ID number, and patient trend graphs. The icons identify the various parameters. Clicking on each icon reveals a graph with corresponding variables.
Patient record Icon
Documentation for DTM Users Only: Patient Records
Slide16Documentation for DTM Users Only: Table Review
Patient Measurements Table
Tabulated measurements for a patient include includes Date, Time, Mode, Mean Arterial Pressure (MAP) and Result. Under the mode column, DLVFLW = Delivered Flow, AXSFLW = Access Flow, REC = Recirculation
, CO = Cardiac Output and IVT = Intervention
Patient Measurements Table Icon
Slide17Transonic Recirculation Measurement
Recirculation generally occurs when access flow (AF) is less then the Transonic Delivered Flow (QB) in AVF or AVG.
Transonic® ultrasound dilution technology separates actual peripheral vascular access recirculation from cardiopulmonary recirculation (CPR).
Because of this, the measurement of zero percent access recirculation is the recirculation standard.
Modalities which cannot separate cardiopulmonary recirculation from access recirculation will indicate false positive recirculation.
Slide18Recirculation Measurement Method
Saline is introduced into the Venous Bloodline with the dialysis lines in the normal position
Venous Sensor detects the saline dilution
If Recirculation is present, the diluted venous blood is pulled backwards into the arterial bloodline
Arterial Sensor detects the saline dilution inside the arterial Bloodline
The dilutions curves calculate the percent of recirculation
Image depicts needles inside AVF/AVG with recirculation present
Slide19Recirculation Measurement in Hemodialysis Catheters
No Recirculation
Venous blood is pulled back into the arterial catheter’s lumen
Recirculation
Slide20Catheters
Recirculation Results Interpretation By Access Type
AV Graft or AV Fistula
If the Recirculation is greater than 10%, the patient is not achieving the targeted dialysis dose.
Utilize the Transonic “Optimization of
Hemodialysis Catheter Adequacy
Algorithm” to guide an on-the-spot correction.
Check for inadvertent reversal of bloodlines. This is when the Arterial needle location is actually the venous needle location. This can occur with a reverse flow loop AV graft. An AV fistula can also have bi-directional flow depending on the vessel anatomic configuration.
True recirculation occurs when the Access Flow is close to the set blood pump speed. Proceed to an Access Flow measurement to complete the assessment for stenosis.
Check for stenosis between the needles. Proceed to an Access Flow measurement to complete the assessment for stenosis.
Slide21Interpretation Tools for Recirculation in AVF/AVG
Available in the Transonic Resources
Slide22Dialysis Machine Without Compensated Blood Flow Rate
Dialysis Machine With Compensated Blood Flow Rate
Optimization of Hemodialysis Catheter Adequacy Algorithm without Compensated Blood Flow Rate
Optimization of Hemodialysis Catheter Adequacy Algorithm with Compensated Blood Flow Rate
Optimization of Hemodialysis Catheter
Adequacy Algorithm
Slide23Transonic Tools at
www.Transonic.com
Slide24Transonic HD03 Tools
www.Transonic.com
Customer Updates & Training Web Portal
Software Updates
Training Materials
Training Videos
Training Checklists
Operator’s Manuals
Slide25Customer Login to Access the Partner Portal
You can click on
any of the three buttons to access the Partner Portal
Top right of the home page
Click on Contact Us then select Partner Portal
Click on Software Updates on the bottom of the home page
Slide26Complete the Form to Create Your Account
Select HD03 from the dropdown box
Use a facility email address if your facility has a general email address.
Notifications about your HD03 will be sent to the email used to register.
Slide27Email Confirmation
Slide28Partner Portal Home Page
Click on HD03 Customer
Slide29Partner Portal Home Page
You
can save the password on your computer, so it will auto populate and go to the Partner Portal.
Slide30Partner Portal
Scroll down on the page to find the Tubing List, Software Updates & Manuals
Slide31Additional Questions?
Please refer to the HD03 Operator’s Manual
, Quick Reference Guides, or contact:
Transonic Tech Support 800-353-3569 (US/Canada)
www.Transonic.com